- Browse by Author
Browsing by Author "Department of Otololaryngology-Head and Neck Surgery, IU School of Medicine"
Now showing 1 - 7 of 7
Results Per Page
Sort Options
Item Endoscopic Posterior Cricoid Split with Costal Cartilage Graft: A Fifteen‐Year Experience(Wiley, 2017-01) Dahl, John P.; Purcell, Patricia L.; Parikh, Sanjay R.; Inglis, Andrew F., Jr.; Department of Otololaryngology-Head and Neck Surgery, IU School of MedicineObjective To evaluate outcomes of the endoscopic posterior cricoid split with rib graft (EPCS/RG) procedure in the treatment of subglottic stenosis (SGS), posterior glottic stenosis (PGS), and bilateral vocal fold immobility (BVFI). Study Design Retrospective chart review. Methods Chart review of all patients who underwent EPCS/RG at a single tertiary-care facility between 1999 and 2014. Patients were grouped based on the primary indication for the procedure. Decannulation was the primary endpoint. Secondary endpoints were the number of subsequent airway procedures and length of hospitalization. Results Thirty-three patients were identified; 32 had tracheotomy. Overall decannulation rate was 65.6%. Subgroup analysis demonstrated the following decannulation rates: 53.8% for SGS, 100% for PGS, and 28.6% for BVFI. Fisher exact test found a significant difference in overall decannulation rates between groups (P = 0.002). Operation-specific decannulation rates for patients who never required an open procedure were 23% for SGS, 91.6% for PGS, and 28.6% for BVFI. This difference was also statistically significant (P = 0.001). Multivariate logistic regression analysis found prematurity had a positive correlation with decannulation that approached statistical significance (P < 0.051; odds ratio 6.1; 95% confidence interval 0.99, 37.6). The percentage of patients who underwent repeat airway procedures for the groups was 61.5% for SGS, 16.6 % for PGS, and 14.3% for BVFI. The median length of hospitalization after EPCS/RG was 3 days. Conclusion This represents the largest series of patients who have undergone EPCS/RG and demonstrates that the majority of patients can be decannulated after this procedure. Patients with PGS had the highest operation-specific decannulation rates.Item Measurement of Change in Lower Eyelid Position in Patients Undergoing Transcutaneous Skin-Muscle Flap Lower Eyelid Blepharoplasty(JAMA, 2016-11) Sultan, Babar; Genther, Dane J.; Perkins, Stephen W.; Department of Otololaryngology-Head and Neck Surgery, IU School of MedicineImportance Transcutaneous lower eyelid blepharoplasty is a commonly performed procedure with a postoperative risk of eyelid malposition. Objective To quantify the change in lower eyelid position after transcutaneous lower eyelid blepharoplasty. Design, Setting, and Participants This retrospective medical record review describes patients who underwent transcutaneous blepharoplasty at a private facial plastic surgery practice. Patients with less than 3 months of follow-up, a history of periocular trauma, and concurrent midface lift were excluded. Interventions Bilateral skin-muscle flap lower eyelid blepharoplasties with possible tarsorrhaphy, canthopexy, or canthoplasty as indicated. Main Outcomes and Measures Lower eyelid position determined by measurement of preoperative and postoperative pupil to eyelid and lateral limbus to eyelid distances. Results Data from 100 consecutive patients (mean age, 56.7 years; 92 female [92.0%]) undergoing bilateral skin-muscle flap lower eyelid blepharoplasty were analyzed. The mean increase in distance was 0.33 mm (95% CI, 0.24-0.42 mm) from the pupil to the lower eyelid margin and 0.32 mm (95% CI, 0.23-0.41 mm) from the lateral limbus to the lower eyelid margin at final follow-up. For both measurements, patients undergoing concurrent canthopexy had a significantly greater change in eyelid position (P < .001). Men had a greater change in the distance of pupil to lower eyelid compared with women (0.76 mm; 95% CI, 0.44-1.08 mm, vs 0.30 mm; 95% CI, 0.20-0.39 mm, respectively; P = .008) at final follow-up. Two patients required revision procedures secondary to eyelid malposition, and 25 patients had new onset of dry eye symptoms. Conclusions and Relevance Transcutaneous skin-muscle lower eyelid blepharoplasty with selective performance of canthoplasty or canthopexy causes a small, predictable eyelid position change in this population with a low rate of revision procedures. Level of Evidence 3.Item Middle Cranial Fossa (MCF) Approach without the use of Lumbar Drain for the Management of Spontaneous Cerebral Spinal Fluid (CSF) Leaks(Lippincott, Williams, and Wilkins, 2016-12) Nelson, Rick F.; Roche, Joseph P.; Gantz, Bruce J.; Hansen, Marlan R.; Department of Otololaryngology-Head and Neck Surgery, IU School of MedicineObjective: To determine the efficacy and morbidity of repairing spontaneous cerebrospinal fluid (CSF) leaks with the middle cranial fossa (MCF) approach without the use of a lumbar drain (LD), as perioperative use of LD remains controversial. Study Design: Retrospective review from 2003 to 2015. Setting: University of Iowa Hospitals and Clinics and Indiana University Health Center. Patients: Those with a confirmed lateral skull base spontaneous CSF leaks and/or encephaloceles. Intervention: MCF approach for repair of spontaneous CSF leak and/or encephalocele without the use of lumbar drain. Assessment of patient age, sex, body mass index (BMI), and medical comorbidities. Main Outcome Measure: Spontaneous CSF leak patient characteristics (age, sex, BMI, obstructive sleep apnea) were collected. Length of stay (LOS), hospital costs, postoperative complications, CSF leak rate, and need for LD were calculated. Results: Sixty-five operative MCF repairs were performed for spontaneous CSF leaks on 60 patients (five had bilateral CSF leaks). CSF diversion with LD was used in 15 of 60 patients, mostly before 2010. After 2010, only three of 44 patients (6.7%) had postoperative otorrhea requiring LD. The use of LD resulted in significantly longer LOS (3.6 ± 1.6 versus 8.7 ± 2.9 d) and hospital costs ($29,621). There were no postoperative complications in 77% (50 of 65) of cases. Three cases required return to the operating room for complications including frontal subdural hematoma (1), subdural CSF collection (1), and tension pneumocephalus (1). No patients experienced long-term neurologic sequelae or long-term CSF leak recurrence with an average length of follow-up of 19.5 months (range 3–137 mo). The average patient BMI was 37.5 ± 8.6 kg/m2. The average age was 57.5 ± 11.4 years and 68% were female. Obstructive sleep apnea was present in 43.3% (26 of 60) of patients. Conclusion: The morbidity of the MCF craniotomy for repair of spontaneous CSF leaks is low and the long-term efficacy of repair is high. Universal use of perioperative lumbar drain is not indicated and significantly increases length of stay and hospital costs. Obesity and obstructive sleep apnea are highly associated with spontaneous CSF leaks.Item Modulation of Wnt Signaling Enhances Inner Ear Organoid Development in 3D Culture(Plos, 2016-09-08) DeJong, Rachel E.; Liu, Xiao-Ping; Deig, Christopher R.; Heller, Stefan; Koehler, Karl R.; Hashino, Eri; Department of Otololaryngology-Head and Neck Surgery, IU School of MedicineStem cell-derived inner ear sensory epithelia are a promising source of tissues for treating patients with hearing loss and dizziness. We recently demonstrated how to generate inner ear sensory epithelia, designated as inner ear organoids, from mouse embryonic stem cells (ESCs) in a self-organizing 3D culture. Here we improve the efficiency of this culture system by elucidating how Wnt signaling activity can drive the induction of otic tissue. We found that a carefully timed treatment with the potent Wnt agonist CHIR99021 promotes induction of otic vesicles-a process that was previously self-organized by unknown mechanisms. The resulting otic-like vesicles have a larger lumen size and contain a greater number of Pax8/Pax2-positive otic progenitor cells than organoids derived without the Wnt agonist. Additionally, these otic-like vesicles give rise to large inner ear organoids with hair cells whose morphological, biochemical and functional properties are indistinguishable from those of vestibular hair cells in the postnatal mouse inner ear. We conclude that Wnt signaling plays a similar role during inner ear organoid formation as it does during inner ear development in the embryo.Item Should adult surgical tracheostomies include a Bjork flap?(Wiley, 2017-03) Au, Joshua K.; Heineman, Thomas E.; Schmalbach, Cecelia E.; St. John, Maie A.; Department of Otololaryngology-Head and Neck Surgery, IU School of MedicineItem Tension Pneumocephalus Related to Spontaneous Skull Base Dehiscence in a Patient on BiPAP(Lippincott, Williams, and Wilkins, 2016-10) Wannemuehler, Todd J.; Hubbell, Richard D.; Nelson, Rick F.; Department of Otololaryngology-Head and Neck Surgery, IU School of MedicineSpontaneous pneumocephalus is an uncommon phenomenon that may develop in patients with occult skull base defects. There have been reports of pneumocephalus occurring spontaneously in the setting of continuous positive airway pressure (CPAP) use (1). Tension pneumocephalus represents a neurosurgical emergency where intracranial air is trapped with increasing pressures resulting in neurological deterioration (2). Previous literature has also documented the growing understanding of how obesity, elevated intracranial pressure (ICP), obstructive sleep apnea (OSA), and cortical skull thinning are associated with spontaneous tegmen dehiscence and cerebrospinal fluid (CSF) leakage (3). Other mechanisms for spontaneous CSF leak include aberrant arachnoid granulation, congenital skull base dehiscences, increased abdominal and thoracic pressure resulting in reduced cerebral venous drainage, and age-related cortical thinning. In this report, we present the case of a bilevel positive airway pressure (BiPAP) user with an undiagnosed spontaneous tegmen dehiscence who developed spontaneous tension pneumocephalus.Item Transcutaneous Skin-Muscle Flap Suspension Lower-Eyelid Blepharoplasty(JAMA, 2015-11) Shadfar, Scott; Perkins, Stephen W.; Department of Otololaryngology-Head and Neck Surgery, IU School of MedicineThe transcutaneous lower-eyelid blepharoplasty is a commonly performed surgical technique and an important tool in the armamentarium of facial plastic surgeons. The facets of lower-eyelid blepharoplasty begin with proper patient selection and rely on several technical subtleties that are crucial to achieve an excellent cosmetic and functional result while avoiding potential complications. The senior author (S.W.P) has been using the transcutaneous approach with orbicularis oculi muscle suspension for 30 years to address redundant or excessive skin and muscle while gaining wide exposure to treat pseudoherniation of the orbital fat compartments.